Background. Chronic obstructive pulmonary disease (COPD) is associated with subclinical atherosclerosis and endothelial dysfunction, thereby leading to increased cardiovascular risk. In the present study, we tested the hypothesis that pulmonary rehabilitation is able to improve endothelial function in patients with COPD as assessed by flow-mediated dilation (FMD).

Methods. Consecutive COPD patients referred to Istituti Clinici Maugeri, Telese Terme (BN) for a comprehensive 35-session pulmonary rehabilitation program were screened for inclusion in the present study. FMD was assessed within 24 hours from admission and then at the end of the rehabilitation program. 

Results. A total of 40 patients with COPD (67.5% males, median age 72.5 years) were included in the final analysis. After pulmonary rehabilitation, a significant improvement in spirometry parameters, self-assessment measures of disability and quality of life, and exercise capacity was documented. Moreover, FMD changed from 3.25% (2.31-4.26) to 4.95% (3.57-6.02), corresponding to a 52.3% increase of its median value (P<0.001). Percentage changes (?%) in FMD following pulmonary rehabilitation were positively correlated with percentage changes in forced expiratory volume in 1 second (FEV1) (r=0.365; P=0.028) and FEV1% (r=0.354; P=0.034). A multivariate analysis showed that ?%FEV1 is an independent predictor of ?%FMD (?=0.390; P=0.033).

Conclusions. Results of our study suggest that endothelial function may improve after pulmonary rehabilitation in COPD patients. This potential beneficial effect in terms of cardiovascular risk may be somehow related to the improvement of pulmonary function.